Abstract
Background. Chronic graft rejection (CR) represents an increasing concern in pediatric liver transplantation (LT). Risk factors of CR in this population are uncertain. In present study, we aimed to ascertain if clinical parameters could predict the occurrence of CR in LT children.Methods. We retrospectively analyzed the results from 47 children who had experienced acute hepatic rejection in Namazee hospital, Shiraz, Iran during 2007–2017.Results. Out of 47 children, 22 (46.8%) and 25 (53.2%) were boys and girls respectively. Ascites, gastrointestinal bleeding, and spontaneous bacterial peritonitis were observed in 20 (44.4%), 14 (31.1%), and 4 (9.1%) respectively. Posttransplant vascular and biliary complications were observed in 3 (7%) and 4 (9.3%) cases respectively. The mean time from LT to normalization of liver enzymes was 14.2 ± 7.5 days. The mean of acute rejection episodes was 1.4 ± 0.6 (median = 1 (22, 46.8%), range of 1–3). Six (12.7%) patients experienced CR. The mean time from LT to CR was 75 ± 28.4 days. A significant association was found between CR and patients’ condition (being inpatient or outpatient) before surgery (P = 0.03). No significant relationship was found between CR and post-transplant parameters except for biliary complications (P = 0.01). Both biliary complication (RR = 33.7, 95% CI: 2.2–511, P = 0.01) and inpatient status (RR = 10.9, 95% CI: 1.1–102.5, P = 0.03) significantly increased the risk of CR.Conclusion. Being hospitalized at the time of LT, and development of biliary complications might predict risk factors for development of CR in LT children.
Highlights
In the courtesy of substantial improvements in preand post-transplant care, patients who are organ transplanted encounter lower rate of early complications after surgery
Based on this, studying risk factors related to incidence of chronic graft rejection (CR) is of crucial importance to early identify CR in pediatric liver transplantation (LT)
The means for the numbers of transfused FFP, whole blood, and packed cell units before LT were 1 ± 1.7, 0.4 ± 1.4, 0.6 ± 1.5 respectively. basic clinical features of the patients have been noted in table 1
Summary
In the courtesy of substantial improvements in preand post-transplant care, patients who are organ transplanted encounter lower rate of early complications after surgery. After nearly five decades experience on pediatric LT, survival rate for patients hits 90% in 1-year post transplant [7]. This survival rate could be attributed to improvements in preoperative managements, optimizing donor selection strategies, and developing proficient surgical methods. The majority of these advancements, contribute to lower acute and short-term complications while long-term complications, and in particular, CR, is still relatively common encountered feature. Being hospitalized at the time of LT, and development of biliary complications might predict risk factors for development of CR in LT children
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